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Pancreatic Cysts

The pancreatic cyst can be congenital or acquired and can be subclassified depending on the epithelium lining the cyst. Congenital pancreatic cysts may present as solitary, multiple, or alimentary tract duplications. Von Hippel-Lindau syndrome, trisomy 9, tuberous sclerosis, Meckel-Gruber syndrome, and polycystic kidney disease have been associated with multiple congenital cysts. These cysts may be numerous and can transform the pancreas into a cystic mass (Gazelle et al. 1998; Baker et al. 1990) (Fig. 4.18d,e).

Solitary congenital cysts may be the least common cystic pancreatic lesion, with only 25 documented cases having been reported. Two additional patients were identified on prenatal US scan. Patients with pancreatic cysts may present with an asymptomatic mass upon physical examination or a symptomatic mass with abdominal distension.

CT and US may demonstrate a low attenuating lesion or an anechoic defect typically located in the tail of the pancreas. This lesion can be unilocular or multilocular with multiple septae. The differential diagnosis includes cyst of renal origin, as well as choledochal, mesenteric, ovarian, and urachal cysts. ERCP and HIDA scans can be used to identify communication with the pancreatic duct or biliary tree.

Fig. 4.17a,b. Cystic fibrosis. a Classic chest radiograph. b Echogenic pancreas on US (arrowheads)

On the other hand, pancreatic pseudocysts represent the most common cystic masses in the pancreas. Pseudocysts are usually fluid collections with a thick wall that arise secondary to infections or trauma. Differentiation between a true cyst and a pseudocyst by imaging is very difficult and can only be done by microscopic examination.

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